title: Impact of nonexacerbated COPD on mortality in critically ill patients.
abstract: BACKGROUND
  The real contribution of nonexacerbated COPD to mortality has not been studied. The aim of our study was to evaluate the impact of nonexacerbated COPD on mortality in patients requiring mechanical ventilation (MV).
  
  
  METHODS
  This prospective, observational study included critically ill, ventilated patients without evidence of respiratory infection. Patients with COPD comprised the study group. Clinical and demographics variables were recorded. The main end point was ICU mortality.
  
  
  RESULTS
  Of the 235 patients included, 60 (25.5%) intubated patients had COPD. The remaining 175 (74.5%) comprised the control group. Those with COPD were more often medical patients who were older and had a higher number of comorbidities and a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score than intubated patients without COPD (P < .05). The overall ICU mortality was 26.3% (62/235) and significantly higher in patients with nonexacerbated COPD (36.7% vs 22.9%, P < .05), with an attributable mortality to COPD of 13.8%. Incidence of ventilator-associated pneumonia was not significantly different between patients with nonexacerbated COPD (11.9/1,000 MV days) and without COPD (16.0/1,000 MV days; P = .40). In the multivariate analysis, only COPD (hazard ratio [HR], 2.1; 95% CI, 1.10-3.94), shock at ICU admission (HR, 2.0; 95% CI, 1.01-4.01), and medical condition (HR, 1.7; 95% CI, 1.01-3.18) were independently associated with mortality.
  
  
  CONCLUSIONS
  Intubated patients with nonexacerbated COPD were not exposed to a higher risk of ventilator-associated pneumonia but had a higher rate of mortality.
authors.affiliation: Critical Care Department, Joan XXIII University Hospital, CibeRes Enfermedades Respiratorias, Universidad Rovira i Virgili-IISPV, Tarragona.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Critical Care Department, Joan XXIII University Hospital, CibeRes Enfermedades Respiratorias, Universidad Rovira i Virgili-IISPV, Tarragona.
authors.forename: Thiago
authors.initials: T
authors.lastname: Lisboa
authors.affiliation: Critical Care Department, Dr Negrín University Hospital, Las Palmas de Gran, Canaria.
authors.forename: Jorge
authors.initials: J
authors.lastname: Solé-Violán
authors.affiliation: Microbiologic Department, Joan XXIII University Hospital, CibeRes Enfermedades Respiratorias, Universidad Rovira i Virgili-IISPV, Tarragona.
authors.forename: Federico
authors.initials: F
authors.lastname: Gómez
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, VHIR-Universitat Autonoma Barcelona, CibeRes, Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Roca
authors.affiliation: Critical Care Department, Joan XXIII University Hospital, CibeRes Enfermedades Respiratorias, Universidad Rovira i Virgili-IISPV, Tarragona.
authors.forename: Sandra
authors.initials: S
authors.lastname: Trefler
authors.affiliation: Respiratory Department, Hospital del Mar, IMIM-UPF, CibeRes, Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gea
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, VHIR-Universitat Autonoma Barcelona, CibeRes, Barcelona, Spain.
authors.forename: Joan R
authors.initials: JR
authors.lastname: Masclans
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, VHIR-Universitat Autonoma Barcelona, CibeRes, Barcelona, Spain. Electronic address: jrello.hj23.ics@gencat.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D012121:Respiration, Artificial